Abstract Listings 2024

Purpose

Objective: To highlight an unusual presentation of peri-orbital cellulitis in a child with Goldenhar Syndrome. This case underscores the pivotal role of visual and clinical diagnosis, supplemented by blood tests, while advocating for judicious use of imaging modalities due to their complications in Paediatric cases, as highlighted by some studies (Crosbie et al., 2016).

Methods

Methods: A 2-year-old child with Goldenhar syndrome presented with acute unilateral orbital swelling, without typical features of orbital cellulitis such as ophthalmoplegia, or fever. Further history revealed preceding coryzal symptoms. Ophthalmic examination revealed pseudo-proptosis, fullness of the orbit, and severe upper lid tarsal conjunctival hypertrophy, mimicking a protruding mass covering the entire eyeball. Further examination revealed soft tissue swelling, no palpable mass in the orbit, white conjunctiva, and a clear cornea, indicating no ocular involvement. Blood tests showed elevated total leukocyte count (TLC) with predominantly high neutrophil and monocyte counts and normal CRP levels. Nasopharyngeal aspirate analysis and cultures were negative for any bacterial and viral agents, including COVID-19. Differential diagnoses included a localized allergic reaction, peri-orbital cellulitis, and rhabdomyosarcoma. Eye swabs and blood cultures did not show any growth. A CT scan was deferred for 24 hours due to radiation concerns (Tsimpida et al.,2010)

Results

Results: After careful consideration and discussion with paediatric team, following our local trust’s protocol-guided management for peri-orbital cellulitis (Tsimpida et al., 2010), treatment with IV ceftriaxone was initiated, resulting in significant improvement after the first dose. Complete resolution of swelling supported the diagnosis of peri-orbital cellulitis.

Conclusion

Conclusion: This case underscores the necessity of considering atypical presentations of peri-orbital cellulitis which can mimic orbital cellulitis or Rhabdomyosarcoma particularly in paediatric patients with underlying syndromes such as Goldenhar syndrome. Additionally, the presence of a high TLC count with lower occurrence of ophthalmoplegia and proptosis in younger children must also be considered (Tsirouki et al., 2016). Prompt initiation of appropriate antibiotic therapy, guided by clinical response, is essential for successful management. Multiple studies have emphasized the importance of clinical diagnosis over imaging in paediatric cases of orbital cellulitis (Tsimpida et al., 2010; Crosbie et al., 2016). This highlights the need for careful clinical assessment and judicious use of imaging modalities to avoid unnecessary radiation exposure, emphasizing the value of interdisciplinary collaboration and tailored patient care.

Additional Authors

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